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Doctors Debate Universal Health Care: Pros and Cons From the Experts

American doctors argue their opinions on universal health care: Is it socialized medicine or a compassionate, necessary program? Get the facts and learn the issues from the United States health-care professionals themselves.

[Editor’s note: This article was originally hosted on MyFamilyDoctorMag.com, our sister site. It’s now featured here as part of our new general-health section.]

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One of the top issues on your mind this year is likely to be health care. Buzz word: universal.

“Health insurance is expensive, and not everyone can afford it,” goes one argument. “The government should provide everyone with access to paid-for health care.”

“That’s not fair,” goes the other. “For example, why should everyone have to pay for people who choose not to take care of themselves, such as smokers?”

And the debate rages on, with many more pros and cons, facts and figures and ideologies making the details of each argument downright interesting and utterly important.

Rules of Engagement

We invited each participant to write an argument, then read the opponent’s argument and, if desired, write a rebuttal. Neither was allowed to read the other’s initial argument before writing his own, and neither could read the other’s response before rebutting.

We asked two doctors with strong opinions on the topic to share their side. Here’s what they had to say.

How can there be a debate over whether universal health care is itself a desirable goal? A 2002 Institutes of Medicine study concluded that more than 18,000 Americans die every year because they’re uninsured. Some kind of health coverage for every citizen would mean fewer child deaths from asthma, fewer cancer deaths in minority communities and fewer veterans who depend on emergency rooms for their primary care.

The real questions are how universal care would be paid for and who would decide levels of reimbursement

The first myth concerns what universal health care is: a broad term that could mean anything from government financing (as in Medicare/Medicaid for all) to use of tax law to bring everyone into the private health-insurance system (as recently enacted in Massachusetts under Republican Governor Mitt Romney).

Health insurance companies spend heavily to condemn something called “socialized medicine,” recognizing that any single-payer plan would likely result in heavy losses for their industry. But no major organizations or national political figures have advocated creating a system like Great Britain’s, where the government owns all the facilities and employs all the doctors and nurses.

Two other myths about universal care are that doctors oppose it and that quality of care would suffer.But a plurality of physicians, particularly primary-care doctors, supports national health insurance. And there is now strong evidence that, even in developed countries with addiction problems like ours, universal coverage correlates with improved quality of health across the socioeconomic spectrum.

Against

Against

John S. O’Shea, M.D., M.P.A., F.A.C.S., practicing general surgeon and former fellow with conservative think tank The Heritage Foundation.

America is often criticized for its lack of a universal health-care system comparable to the Europeans and Canadians, even though Germany, the United Kingdom and even Canada are increasingly turning to the private sector in order to relieve the financial burden on government and solve serious delivery problems, most notably “rationing by queue,” the prolonged wait times for many services, including cancer treatment and cardiac surgery.

Get in on the Debate!

Compared to the private sector, government programs are inefficient, and the higher costs have to be paid for with higher taxes or spending cuts in other areas such as defense, education, or even medical research and development. This is a tradeoff that most Americans would not be willing to make.

If low-income persons find health-care coverage unaffordable, they should be subsidized by the government, but they should retain ultimate ownership of their health-care resources and the choice about how those resources will be utilized.Such patient ownership and choice will create the demand for price and quality transparency necessary to make value-based health-care decisions.

The fundamental flaw in universal health-care systems is a misplacement of incentives. The decisions that drive health-care costs and quality of care are made by individual patients and their health-care providers. These decisions should not be influenced by universal government mandates, administered pricing systems or expenditure targets, but should instead be based on an adequately informed assessment by individual patients and their providers about the value of services in a particular clinical situation.

Rebuttals

Dr. O’Shea’s- -The author is correct that “universal health care” is a desirable goal. However, this goal will not be achieved by simply expanding the role of government or mandating universal coverage. Coverage is not the same as health care. For example, according to CDC statistics, Medicaid/SCHIP beneficiaries use the emergency room for non-urgent problems at even a higher rate than the uninsured, due to a lack of access to primary care. More money is also not the answer. Changing incentives to give patients ownership and control of their health-care resources will lead to a more efficient, higher quality, value based health care system.

Dr. Whelan’s- -Government already covers more than half our health care. Expanding Medicare to include the 20 percent of costs covered by employers (plus coverage for the uninsured) isn’t inevitably more inefficient or costly. It’s false to label all government programs as inefficient since Medicare’s overhead is one-tenth that of private insurance. Public financing doesn’t automatically disincentivize quality health care—considering that our government dominates U.S. biomedical research funding, and the world’s greatest scientists are competing intensely for those dollars. Groups like The Heritage Foundation, sponsored by the insurance industry, offer these arguments to hide their major concern with universal health care: that it jeopardizes insurance industry profits.